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Return-to-Play for Athletes With Heart Conditions

Athlete Woman Running EKG

Returning to a sport or exercise regimen after an injury can be daunting. Doing so after being diagnosed with a heart condition can feel like a life-or-death decision.

To help alleviate some of that anxiety, we’ll discuss the leading guidance on returning to a sport or exercise for four different kinds of heart conditions:

  • Heart murmurs
  • Genetic heart diseases
  • Congenital heart disease
  • Coronary artery disease

For advice about when and how to proceed with your specific symptoms, consult your cardiologist.

Heart Murmurs

Most heart murmurs detected in athletes are not a signal that anything’s wrong. A murmur is the sound of blood rushing through the heart much like the sound of water rushing through pipes. In young and healthy hearts, it is a common finding reflective of normal function. In response to consistent aerobic exercise, the heart can become slightly enlarged, which helps it move greater amounts of blood each time it contracts.

Less frequently, a murmur can be related to narrowing or leaking of one or more of the heart’s valves, or even a small hole in the heart. A murmur could also stem from a genetic condition called hypertrophic cardiomyopathy that can reduce or block blood flow from the left ventricle to the aorta.

In those instances, intense exercise can stress the heart, which could lead to an irregular heartbeat or a deterioration in heart function.

Your cardiologist should be able to distinguish the nature of your murmur based on its timing and pitch. They may also recommend an echocardiogram: an ultrasound of the heart that shows how well the heart is pumping and how efficiently the valves operate.

If a heart murmur isn’t related to an underlying condition, you should be able to return to exercise or competition without hesitancy.

Genetic Heart Diseases

Genetic heart diseases, or inherited heart diseases, can lead to structural abnormalities in the heart and dangerous irregular heart rhythms. In ventricular fibrillation, the heart’s electrical system causes the heart to quiver instead of squeeze blood to the rest of the body. If it’s not treated immediately, it can be fatal.

Exercise was once believed to increase the risk for ventricular fibrillation and other kinds of cardiac arrest for patients with inherited heart conditions. Cardiologists traditionally advised against athletics for these patients, in keeping with guidelines put out by the American Heart Association and American College of Cardiology in 2005.

But in 2015, the guidelines changed in response to new research. It’s now recommended that athletes receive a thorough examination from a specialist in genetic heart diseases and follow a personalized management plan to exercise safely.

Congenital Heart Disease

Similarly, doctors traditionally restricted exercise for children with congenital heart disease. Congenital heart diseases are caused by abnormalities in the heart’s development and affect about one in 100 kids in the United States. But restrictions have changed in recent years.

“Research on patients with congenital heart disease, even complex disease, has shown that routine moderate exercise is safe and can be beneficial,” says the American Heart Association.

Shaun White, the Olympic gold medalist and professional snowboarder, has become a shining example of leading a healthy, active life with congenital heart disease – as long as young athletes continue to undergo regular assessment and care.

It’s also important to recognize that each congenital heart defect is unique, so limitations may vary from person to person. Cardiologists can use ongoing monitoring to determine how much dynamic and static exercise a person can tolerate.

Coronary Artery Disease

Coronary artery disease is the most common type of heart disease in the U.S. Fatty deposits on the inner walls of the arteries can block the arteries and lead to a heart attack.

However, most people with coronary artery disease can play competitive or amateur sports. What’s more, regular exercise can prevent heart disease and reduce the odds of premature death in people with heart disease.

For weekend warriors and competitive athletes alike, awareness is key. If exercise causes palpitations, unusual shortness of breath, or chest discomfort seek prompt medical attention. In highly trained individuals, the symptoms of coronary disease can be subtler including reduction in athletic performance.

About this Blog

The Penn Heart and Vascular blog provides the latest information on heart disease prevention, nutrition and breakthroughs in cardiovascular care.


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